Provider Demographics
NPI:1659170645
Name:VANGUARD MEDICAL LLC
Entity type:Organization
Organization Name:VANGUARD MEDICAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RICARDO
Authorized Official - Middle Name:
Authorized Official - Last Name:GONZALEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:571-379-5716
Mailing Address - Street 1:8577 SUDLEY RD STE C
Mailing Address - Street 2:
Mailing Address - City:MANASSAS
Mailing Address - State:VA
Mailing Address - Zip Code:20110-3860
Mailing Address - Country:US
Mailing Address - Phone:571-379-5716
Mailing Address - Fax:571-576-0915
Practice Address - Street 1:8577 SUDLEY RD STE C
Practice Address - Street 2:
Practice Address - City:MANASSAS
Practice Address - State:VA
Practice Address - Zip Code:20110-3860
Practice Address - Country:US
Practice Address - Phone:571-379-5716
Practice Address - Fax:571-576-0915
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-03-11
Last Update Date:2025-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies